When assessing a child after heart surgery to correct Tetralogy of Fallot (TOP) which finding should alert the nurse to suspect a le carat output?

Altered level of consciousness and treaty pulse

Bounding pulses and mottled skin

Capillary refill of 2 seconds and blood pressure of 96/47 mmHg

Extremities warm to the touch and pale skin

Answer and Explanation

The Correct Answer is A

A.Altered level of consciousness and thready pulse.

In a child after heart surgery to correct Tetralogy of Fallot (TOF), a thready pulse and altered level of consciousness can be indicative of poor cardiac output. This may suggest that the heart is not effectively pumping blood to meet the body's needs.

B. Bounding pulses and mottled skin: Bounding pulses and mottled skin are not typical signs of decreased cardiac output. Bounding pulses are often associated with increased cardiac output.

C. Capillary refill of 2 seconds and blood pressure of 96/47 mmHg: A capillary refill of 2 seconds is within the normal range, and a blood pressure of 96/47 mmHg is reasonable for a child. These findings do not necessarily indicate poor cardiac output.

D. Extremities warm to the touch and pale skin: Warm extremities and pale skin are not typical signs of decreased cardiac output. Cold extremities and cyanosis may be more concerning signs.

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Correct Answer is B

Explanation

A. "The body's response to gluten causes the intestine to become more porous and hang on to more of the fat-soluble vitamins, leading to vitamin toxicity." This answer is not accurate. The issue in celiac disease is malabsorption, not vitamin toxicity.

B. "The body's response to gluten causes damage to the mucosal cells in the intestines leading to absorption problems."

Celiac disease is an autoimmune disorder in which the ingestion of gluten (a protein found in wheat, barley, and rye) leads to damage of the mucosal cells in the small intestine. This damage, in turn, can lead to malabsorption of essential nutrients, including vitamins, minerals, and other important components of the diet. It is important for individuals with celiac disease to avoid gluten-containing foods to prevent ongoing damage to the intestinal mucosa and improve nutrient absorption.

C. "The body's response to consumption of anything containing gluten is to create special cells called villi, which leads to more diarrhea." This statement is not accurate. Celiac disease leads to damage to the villi (finger-like projections) in the small intestine, not the creation of special cells. It can lead to diarrhea but is not the primary cause.

D. "The body's response to gluten causes damage to the mucosal cells, leading to malabsorption of water and hard, constipated stools." This response is not accurate. Celiac disease is more commonly associated with diarrhea and malabsorption, not constipation and malabsorption of water.

A. Provide activities for the sing to do at home B. Avoid interruptions by coordinating using actions C. Anwer questions honestly and clearly D. Encourage the sibling to write in a journal

Correct Answer is C

Explanation

A. Provide activities for the sibling to do at home: While providing activities can be a good way to engage the sibling and offer a distraction, it may not address their need for understanding and emotional support. Answering questions and providing information about the condition is more directly beneficial in this context.

B. Avoid interruptions by coordinating using actions: This option is not clear and may not directly address the social support needs of the sibling. It's important to have open communication and address their concerns rather than coordinating actions to avoid interruptions.

C. Answer questions honestly and clearly.

In a situation where a 10-year-old sibling of a child with a complex chronic condition needs social support, providing honest and clear answers to their questions is essential. It's important to address their concerns and provide information in an age-appropriate manner. Children can feel anxious or confused when a sibling has a complex chronic condition, and providing honest and clear answers helps them understand the situation better and reduces their anxiety.

D. Encourage the sibling to write in a journal: While journaling can be a helpful coping strategy, it may not be the most immediate response to their social support needs. Answering questions and providing emotional support should come first.

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When assessing a child after heart surgery to correct Tetralogy of Fallot (TOP) which finding should alert the nurse to suspect a le carat output?

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